Psoriasis

Psoriasis is a common chronic, non-contagious, benign, hyperproliferative and immunological skin condition that is often genetically inherited and sometimes associated with disorders of the joints and nails (affecting 2% of the population). It affects female and male patients equally. There is no cure for psoriasis but there are many effective treatments to keep it under control. Psoriatic arthritis can causes swelling and stiffness in the joints and this aspect of the condition would be managed by a rheumatologist alongside your skin specialist.

Skin affected by psoriasis is red and scaley. The skin changes of psoriasis are often well-defined red plaques with a surface white scale. It can have a different appearance in certain sites like underneath the breasts, axillae or groin. Patients sometimes complain of itch or burning. Certain sites like the scalp or the groin can be particularly itchy. Some patients find the app

earance of the rash very embarassing and will not use public swimming pools, beaches etc. If you have a family member affected by psoriasis you are far more likely to get the disease. Infections, stress, damage to the skin, alcohol and some prescription medication (B-blockers, lithium, anti-malaria tablets) can trigger attacks of psoriasis.

Several patterns of psoriasis are recognised. The most common ones are:

Chronic Plaque Psoriasis- this is the most common. It is easily recognised by the appearance of the well-defined red,raised, plaques with adherent thick silvery scale.

Guttate Psoriasis – this is commonly the first presentation of psoriasis at the clinic. The patient has multiple small plaques of psoriasis all over the body and this will not always be recognised by the GP. It is often preceded by a streptococcal throat infection (some doctors advocate removing tonsils) and can clear completely or persist (patients whose rash persists are far more likely to have a positive family history of psoriasis).

Palmo-plantar psoriasis- this is psoriasis affecting the palms and soles. This is always associated with smokers. Treatment does not always work.

Nail psoriasis can affect the cosmetic appearance of the nails (thickening and yellowing of the nails). Female patients are bothered by this but sometimes nail varnish will camouflage it. Functional problems with the nails are far more serious. There can be separation of the nail plate from the nail bed which can make opening boxes etc very difficult and painful. Topical treatments for nails are not especially effective and sometimes oral medication will need to be discussed.

Treatment of the psoriasis depends on your individual circumstances. Topical treatments are usually very effective. However they can be too work intensive for the patient and sometimes more is needed. Phototherapy is ultraviolet light delivered in a controlled way to treat psoriasis. A course of treatment takes between 8-10 weeks and is done in a hospital. It doesn’t always work and exposure to UV increases your lifetime risk of skin cancer. Hospital have strict protocols on how much UV light they will expose a patients to over a lifetime. Some patient report fantastic results but often, the psoriasis will return after a course of treatment, so topical therapies may still be required for maintenance.

Systemic (oral treatments) include acitretin (related to vitamin A), methotrexate( slows down the rate at which cells are dividing in psoriasis ) and ciclosporin (suppresses the immune system). These are available from your Dermatologist at the clinic.

Injectable treatments for psoriasis include etanercept, adalimumab, infliximab etc. Blood tests and close monitoring will be required before and during treatment. These are available from your Dermatologist at the hospital.